Tag: health policy

Even when you’re trying to eat healthy foods, it can be hard to know what to buy: Few us have the time to decipher the nutrition facts on every item we’re considering at the grocery store, and the dizzying number of health claims plastered on labels make the task, if anything, more confusing. The Institute of Medicine offered a possible solution in a report released yesterday: put a simple, standardized rating—zero to three stars or checkmarks—on every food package.

What’s the News: Global health officials are expected to decide whether to destroy the world’s last caches of smallpox at the 64th World Health Assembly this week. The disease was declared eradicated by the World Health Organization in 1979, but two small stores of the virus remain: one at the Centers for Disease Control and Prevention in Atlanta and one in a Russian government lab.

Now, public health officials are divided on how to ensure that the disease stays eradicated. Some say our best bet is to keep the remaining samples of the virus safe and continue to study them, then destroy them at a later date; others say the safest course is to destroy them now, once and for all.

Swine flu is not gone, and it is not stagnant. Though the public health scare about the 2009 swine flu pandemic subsided, the virus—like avian flu—remains in pockets of animals, shuffling its genes while hidden from the watchful eyes of virus experts. Virologists call this genetic switcheroo “reassortment,” and it’s how new and dangerous strains of flu snuck up on humankind in the past—and how they could do it again. This time, though, virologist Jinhua Liu and colleagues are trying to get a jump on the viruses.

For a new study in the Proceedings of the National Academy of Sciences today, this team of Chinese researchers simulated what could be a dire situation for humans: swine flu (H1N1) and avian flu (H9N2) together in one animal. When these flu strains are together they can exchange genetic material. So to test what that mixing might produce, Liu’s team swapped genes between the two and created 127 hybrid viruses, testing each on mice.

Eight of these hybrid strains turned out to be more virulent and dangerous in the mice than their parent strains of swine flu and bird flu. [National Geographic]

According to Dutch virologist Ab Osterhaus, we can’t be sure that these eight nasty strains are the ones that would hit humans hardest—animal studies aren’t perfect.

“Mice mirror, to a certain extent, what happens in humans,” he says, but they are not perfect model animals. Liu agrees. He plans to investigate how contagious his new viral blends are in guinea pigs and ferrets—animals whose respiratory system better reflects our own feverish battle with flu. [ScienceNOW]

As more hospitals have begun using DNA testing to analyze babies with birth defects, doctors have occasionally discovered that a family’s little bundle of joy is also a product of incest. Since this is a new dilemma brought on by the spread of technology, doctors are now debating how to handle these incest surprises.

Geneticist Arthur Beaudet at Baylor College of Medicine addressed the issue yesterday in an article in the medical journal The Lancet. The genetic test, the single nucleotide polymorphism-based array, helps doctors identify missing genes (and can therefore help explain a child’s birth defect or disability)–but it also identifies swaths of identical DNA that a child may have inherited from two closely related parents.

In the few months that Baylor has been performing these detailed genetic tests, there have been fewer than 10 cases of consanguinity — the phenomenon of inheriting the same gene variations from two closely related people, said Dr. Arthur L. Beaudet, chairman of Baylor’s department of molecular and human genetics. However, wider use of such testing in children with disabilities is expected to identify additional cases of incestuous parentage. [ABC News]

The birth defect spina bifida is a devastating condition, often leading to a life of cognitive disability and even paralysis. But for a new study in the New England Journal of Medicine, doctors have shown that fetal surgery conducted in utero, though tricky and carrying some risk, can help to fight the ravages of this affliction.

The study focused on women carrying fetuses diagnosed with myelomeningocele, the most common and most severe form of spina bifida, in which the spinal cord bulges outside the spinal column. The condition can result in lifelong cognitive disabilities, fluid on the brain, bowel problems and paralysis. Typically surgeons operate on such babies within a few days of birth. [Science News]

The option of performing surgery before birth—sealing the opening in the spinal column while the fetus is in the womb—has actually been around for more than a decade.

But no one knew if operating before birth was preferable to operating after. What they did know was that fetal surgery had a number of complications, including causing premature birth, which in some cases killed babies who would otherwise have survived. [ScienceNOW]

For a century, one of the standard procedures for treating women with breast cancer has been the painful removal of the lymph nodes from under the arm, with the belief that this would hamper the cancer’s ability to spread, and extend patients’ lives. A study out in the Journal of the American Medical Association, however, is turning heads by suggesting that—in some cases—this common wisdom be overturned.

For women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling. [The New York Times]

The “20 percent of patients” are those who fit the same criteria as the breast cancer patients in this study: women with early-stage tumors and no noticeable swelling of the lymph nodes, and whose cancer hadn’t spread. All 891 women in the study had a lumpectomy, meaning not all but part of the breast was removed to get the tumor. Of the 891 women, 445 had their lymph nodes removed while 446 didn’t.

[The researchers] found no significant difference in the patients’ chances of surviving five years after their diagnosis. The five-year “disease-free” survival rate was 83.9 percent in those who did not have the more aggressive surgery compared with 82.2 in those who did, the researchers reported. [Washington Post]

The overall survival rate was 91.8% for women who had nodes removed and 92.5% for those who didn’t—again, not a statistically significant difference.

Now that humanity has beaten back and nearly eliminated the once-widespread threat of polio, Bill Gates wants to finish it off for good. To some observers, though, it’s just not worth the money.

The multi-billionaire recently issued his annual letter (pdf) through the Bill & Melinda Gates Foundation, outlining its goals. Gates has been a big donor to world health programs and fighting polio in particular, and his letter calls for eradicating polio once and for all.

There would be many benefits to eradicating the disease entirely, Gates argues — not just medical and financial, but moral. “Success will energize the field of global health by showing that investments in health lead to amazing victories,” he wrote. “The eradication effort illustrates so well how a major advance in the human condition requires resolve and courageous leadership. To win these big important fights, partnerships, money, science, politics and delivery in developing countries have to come together on a global scale.” [Los Angeles Times]

Medical science, supported by billions of philanthropic dollars, has already cut down the specter of polio around the world to a shadow of what it once was. The World Health Organization estimates that there were 1,500 cases of polio around the globe in 2010, down from 350,000 in 1988. To wipe out the last remnants of wild poliovirus, Gates proposes vaccinating youths under five in countries like Afghanistan and India where pockets of polio remain.

Bath products never sounded so dangerous before. Two methamphetamine-like drugs that are being sold as mere “bath salts” have been linked to hallucinations and suicides, and lawmakers around the country are cracking down. Three states have already banned the substances, and this weekend Senator Charles Schumer announced that he’ll introduce a bill to outlaw the substances at the federal level.

“These so-called bath salts contain ingredients that are nothing more than legally sanctioned narcotics, and they are being sold cheaply to all comers, with no questions asked, at store counters around the country,” said Schumer, a New York Democrat. [Reuters]

The drugs, mephedrone and methylenedioxypyrovalerone (MDPV), can be snorted, injected, or smoked. They have no connection to real bath salts–the scented powders and crystals added to bath water for relaxation. The drugs are commercially labeled with such innocuous names as TranQuility, Blue Silk, and White Lightning, but authorities agree that the effects are anything but innocuous:

Psychotic reactions to snorting the “bath salts” reportedly led one woman to swing a machete at her 71-year-old mother in an attempt to behead her, Panama City Beach police said. Also, a man high on the brand Blue Silk tore up the backseat of a patrol car with his teeth after seven Bay County Sheriff’s Office deputies wrestled the crazed man into the cruiser, the agency said. [Los Angeles Times]

You’ve heard of the placebo effect—the tendency for patients who receive a phony treatment like a sugar pill to feel better just because they think the treatment will help them. That standard definition relies on deception. Surely the placebo effect doesn’t work if you tell the patients they’re taking placebos, right?

Can doctors justifiably prescribe placebos to their patients? The standardansweris no. Doing so patronises the patient, undermines their trust, and violates the principles of informed consent. It compromises the relationship between doctor and patient. At worst, it could do harm.

But many of these arguments are based on the idea that placebo effects depend on belief; people must expect that treatments will work in order to experience any benefits. For a doctor to prescribe a placebo, they’d need to deceive. But according to Ted Kaptchuk from Harvard Medical School, deception may not be necessary. In a clinical trial, he found that patients with irritable bowel syndrome (IBS) felt that their symptoms improved when they took placebo pills, even if they were told that the pills were inactive.